Gonococcal mastitis. / Gonokokkmastitt.

A young woman experienced pain and swelling in a non-lactating breast. The culture test result showed an unusual microbe, which is increasingly prevalent in Norway and internationally.

Patient outcomes after electrical injury - a retrospective study.

INTRODUCTION: People exposed to electrical injuries are often admitted to hospital for observation. Current evidence suggests that patients who have a normal ECG on admission after a low-voltage injury, with no loss of consciousness or initial cardiac arrest may be discharged home after a short observation time. Currently, there are no established standards for the duration of monitoring after electric shock, but 24 h of observation is the most commonly adopted approach. We carried out a retrospective study of patients admitted after electrical injuries to determine the in-hospital outcomes and 30-day mortality in these patients. METHODS: We performed a chart review of all patients with electrical injuries admitted to Østfold Hospital, Norway between the years 2001 and 2019, to determine in-hospital and 30-day mortality and the frequency of various cardiac and non-cardiac complications. RESULTS: Mean age of 465 included patients (88% males) was 31 years. Of all injuries, 329 (71%) were work-related, 17 (3.7%) involved loss of consciousness. Furthermore, 29/437 (6.6%) were high voltage (> 1000 V), and 243/401 (60.6%) were transthoracic injuries. 369 (79.4%) were discharged same day. None of the admitted patients died in hospital nor did any die within 30 days of admission, yielding a 30-day mortality of 0% (95% CI 0-0.8). At admission troponin was elevated in three (0.6%) patients, creatinine kinase (CK) in 30 (6.5%) and creatinine in six (1.3%). Electrocardiogram (ECG) abnormalities were described in 85 (18%) patients. No serious arrhythmias were detected. When comparing high- vs low-voltage or transthoracic vs other injuries, there were no significant differences between most of the outcomes, except for more ECG abnormalities in the transthoracic group, whereas more patients had elevated CK, and fewer discharged the same day in high-voltage injuries. CONCLUSION: No in-hospital nor 30-day mortality or serious arrhythmias were encountered in those who were assessed, regardless of the type of injury. Troponin and creatinine were rarely elevated. It seems that conscious patients admitted with a normal ECG following a low-voltage injury may safely be discharged home after a quick clinical assessment including ECG.

The mean bilateral proximal extension of the clot is associated with pulmonary embolism severity parameters and management-associated outcomes.

BACKGROUND: The value of the proximal extension of the clot in risk stratification of pulmonary embolism (PE) has not been established. The mean bilateral proximal extension of the clot (MBPEC) is a computed tomography (CT) radiological score, where initial evaluation showed promising results considering its ability in predicting the severity of PE. PURPOSE: To explore the possible associations between MBPEC and PE-severity parameters, short- and long-term outcomes of PE, and inter-observer agreement. MATERIAL AND METHODS: Patients diagnosed with PE at Østfold Hospital, Norway during 2003-2011 were identified. MBPEC was calculated by calculating the mean of a score in the range of 1-4 assigned for the most proximal extension of the clot in each lung: sub-segmental; segmental; lobar; and main pulmonary arteries. Medical records were reviewed to capture clinical, biochemical, and management-associated data (thrombolysis, admission to ICU). RESULTS: The mean age of 245 included patients was 55 ± 16 years; 42% were women. Patients with higher MBPEC scores had a significantly higher pulse rate and lower oxygen saturation. MBPEC score <4 predicted a negative troponin value with a negative predictive value of 90% (95% confidence interval [CI] 81-95). Patients with MBPEC 4 were 5.3 times more likely to have elevated troponin (odds ratio [OR] 5.3, 95% CI 2.0-14.3). MBPEC score of 4 was independently associated with admission to ICU (OR 3.8, 95% CI 1.8-7.9). The inter-observer agreement was excellent; weighted kappa 0.82. CONCLUSION: MBPEC is associated with PE-severity parameters and can predict short-term adverse outcomes.

Pain and bleeding associated with trephine biopsy.

The study objectives were to determine the intensity and duration of pain, factors that may influence pain experience during and after trephine biopsy, and to assess bleeding and infectious complications related to the procedure. Patients scheduled for trephine biopsy were recruited to the study. Local anesthesia was applied in all patients. Pain intensity was recorded twice daily by the patients using the numeric rating scale (NRS). Bleeding was graded into four grades. Median age of 184 patients was 63 yr. Maximum NRS level was measured at time of biopsy (T0); 167 (91%) patients experienced pain at T0. Median (Q1:Q3) NRS was 3 (1; 5). Median duration of pain was 36 h. Fourteen patients reported pain for more than 7 d. Significant inverse correlation was found between NRS at T0 and age. Pain duration at rest correlated with NRS at T0 and age, while pain duration in activity correlated with NRS at T0, age, and with body mass index (BMI). Mild and moderate bleeding at T0 occurred in 97 (54%) and 18 (10%) patients, respectively; no severe bleeding or infectious complications were registered. Secondary bleeding occurred in two patients; both required hospitalization. In conclusion, the study shows that despite the application of local anesthetic, more than 50% of the patients experienced pain of ≥ 3 points. Procedure-related bleeding is mild to moderate and managed by local pressure only.